O-91 Psychiatric advance directives as part of a rights-based approach to recovery

Abstract

Background English-speaking countries, such as USA, UK, Ireland, Australia, New Zealand, and Canada have embraced Recovery-orientation as a guiding principle of their mental health policy. The recent UN-Convention on the Rights of Persons with Disabilities (CRPD) – historically for the first time – explicitly includes persons with psychosocial disabilities. Aim Discuss how Psychiatric Advance Directives (PAD) can support Recovery-Orientation in times of new human rights legislation in mental health. Methods Non-systematic review of recovery concepts and data in view of current human rights development. Results The 2013 General Comment on Article 12 of the CRPD – Equal Recognition before the Law – by the UN Committee on the Rights of Persons with Disabilities includes a call for the immediate abolition of all substitute decision-making regimes. Research on means and meanings of recovery as well as on the lived experience of coercion underline the importance of choice, self-determination and empowerment for people struggling with mental health problems. Psychiatric advance directives support the realisation of these capacities in a rights-based relationship between persons with mental health problems and the mental health system built on the person’s experience-based expertise. Discussion Support and excitement about possible historical changes as well as confusion, indignation and essential worries have been discussed and formulated in the international mental health community in the light of new human rights challenges for mental health care. Conclusion Psychiatric Advance Directives could play a crucial bridging role for the controversial discourses between long-standing clinical traditions and requirements of currently evolving international human rights standards.